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Starving for Healthcare - JustHealth Helps a Mom | Print |
Written by KRON 4 Staff and John Metz   
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Starving for Healthcare - JustHealth Helps a Mom
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Insurance Hunger Strike Pays Off

hunger.jpg Posted: November 13, 2002 at 5:52 p.m.

SAN MATEO (KRON) -- To what end would a parent go to help a child? A Peninsula woman embarked on a hunger strike last week in a battle over health insurance coverage for her disabled son. A desperate measure for a desperate situation and today, it apparently paid off.

Rain or shine, for the past week Sally Gillette has been walking the pavement in front of her workplace protesting what she calls her company's failure to extend health insurance benefits to her adult son. "I haven't eaten since last Sunday," says Sally. "I just couldn't get anywhere negotiating."

Sally's 23-year-old son is paraplegic with life-threatening complications. His only coverage is Medicaid. "He's on Medicaid but Medicaid is under-funded.," she says. "They don't approve everything he needs."

Employer policies usually cover children as long as they're in school. But when her son dropped out for health reasons, her health plan dropped him. And he became eligible for COBRA.

COBRA, short for Consolidated Omnibus Budget Reconciliation Act, is the insurance that employers must make available at group rates to employees and their families.

Well, negotiations dragged on, and without insurance coverage, Sally says her paralyzed son's condition started deteriorating. "His pain is so bad that he has to lay on his back with his knees pulled back all the time. It's creating pressure sores that now have this antibiotic resistance staph that will kill him if he doesn't find a way to treat the pain so his legs and be straighten again."

"They need to go in there now there is not a minute to lose, says Metz. "Its not about making a deal tomorrow, w hat sally needs is funds for immediate care. And today, after Contact 4 got involved, the company came through. It's offering a 30-thousand dollar advance on whatever her future settlement will be.

"It was for an advance that I went on a hunger strike. So I got what I needed temporarily for my son." The company declined an on-camera interview for this story, but in a statement told Contact 4 that it is working aggressively to resolve the matter. We don't know what the final settlement may be, but we'll stay on top of this story.

 The attached articles provide some of the story, most of it is accurate. But there’s more and some of what’s there is misleading. A few things are: 1) Cigna and the law firm Sally worked for in California were obligated to provide the healthcare to Jesse that they dishonestly, refused to provide, until compelled to do so by Sally’s courageous actions, our intervention and KRON-TV’s coverage; 2) both Cigna and the law firm finally acknowledged this and Jesse’s coverage was reinstated retroactive to when he had been illegally dumped; 3) I believe that Cigna agreed to repay Oregon Medicaid for the money it had paid for some care for Jesse (but not the level of care he would have gotten had the insurance not cheated them), because Cigna had refused to pay; 4) Sally uncovered a host of different systemic acts and practices engaged in by Cigna that are dangerous, deceptive, dishonest, unfair or illegal; and 5) there is every reason to believe that Jesse would be alive today if Cigna hadn’t denied the benefits to which he was entitled – no more, but no less!

John Metz, Director ofJustHealth 

"He acknowledged that the proper notice had not been sent out, so it's the right thing to do to take care of Jesse now. John Metz with California Consumer Healthcare Advocates is helping Sally navigate her way through this medical maze. He says the company offered Sally $60,000 to settle, and the law firm admits it was an oversight. Sally wants $310,000. That's her estimate of what Jesse lost by not getting COBRA coverage.

COBRA covers you for 18 months if you resign or are fired. For 36 months if you're a dependent too old for the employees plan, and 36 months for a newly divorced spouse. Your employer and insurer must notify you. In Sally's case her employer, the law firm of Wilson, Sonsini, Goodrich and Rosati and her insurer, Cigna, failed to do so, leaving Jesse uninsured.

For information on COBRA: www.cobrahelp.com www.insure.com

John Metz - JustHealth 1275 Fourth Street Santa Rosa, CA 95404 1-888-225-2686

http://www.justhealthnow.org

http://www.cchcc.org

(Copyright 2003, KRON 4. All rights reserved.)



 
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